van der Pas R S D, Gresnigt F M J, Wansink L, Franssen E J F, Riezebos R K
Emergency medicine at OLVG hospital, Amsterdam, the Netherlands.
Emergency registrars at Sint Antonius hospital, Nieuwegein, the Netherlands.
Toxicol Rep. 2020 Dec 3;7:1629-1633. doi: 10.1016/j.toxrep.2020.12.003. eCollection 2020.
4-fluoroamphetamine (4-FA) is a novel psychoactive stimulant with a global presence on the drug market. Despite the popularity of 4-FA, data on severe adverse effects are scarce. We present a case of laboratory confirmed 4-FA mono intoxication causing acute heart failure due to a reverse type Takotsubo cardiomyopathy.
A 20-year-old male with no previous medical history and no reported previous drug use, presented to the emergency department (ED) with complaints of headache, nausea and vomiting, approximately 4.5 h after the ingestion of a single 4-FA pill. After 30 min his condition deteriorated with severe hypertension, tachycardia and respiratory failure. Echocardiography showed a reverse type Takotsubo cardiomyopathy. The patient was successfully treated with mechanical ventilation, a phosphodiesterase-3-inhibitor (PDE3-inhibitor) and diuretics. Three months after hospital admission, the patient was free of complaints and his left ventricular function fully recovered.
Recreational use of 4-FA may result in acute onset life-threatening cardiorespiratory toxicity, preceded by severe hypertension, even in drug-naïve patients without any medical history. Emergency physicians and cardiologists should be cautious not to underestimate life-threatening 4-FA complications.
4-氟苯丙胺（4-FA）是一种新型精神活性兴奋剂，在全球毒品市场均有出现。尽管4-FA很流行，但关于其严重不良反应的数据却很稀少。我们报告一例经实验室确诊的4-FA单一药物中毒病例，该病例因反向型应激性心肌病导致急性心力衰竭。
一名20岁男性，既往无病史且无药物使用史，在服用一片4-FA药丸约4.5小时后，因头痛、恶心和呕吐前往急诊科就诊。30分钟后，他的病情恶化，出现严重高血压、心动过速和呼吸衰竭。超声心动图显示为反向型应激性心肌病。该患者通过机械通气、磷酸二酯酶-3抑制剂（PDE3抑制剂）和利尿剂成功治愈。入院三个月后，患者无不适主诉，左心室功能完全恢复。
即使是无任何病史的初涉毒品者，使用4-FA进行娱乐也可能导致急性发作的危及生命的心肺毒性，并伴有严重高血压。急诊医生和心脏病专家应谨慎，切勿低估4-FA危及生命的并发症。
